Feeling Clearly: How Ketamine-Assisted Psychotherapy Helped a Father Overcome Severe Social Anxiety and Childhood PTSD

By Greg Ferenstein

An Unrelenting Specter of Judgment

Tom* couldn’t shake his constant fear of being perceived as awkward and unworthy of friendship.

“I always felt like the outcast,” he recalls. The crippling self-doubt kept all of his relationships at a cold distance, even his wife.

In everyday social situations, even light-hearted water-cooler conversations at work, Tom was haunted by thoughts about why people right in front of him—freely engaging with him in conversation—silently judged him as unpleasant.

Tom had done the work to figure out the source of his dread. After years of therapy, he knew it came from an abusive childhood growing up in a religious culture that used shame and bullying to enforce conformity. As a result, he ran away as a teenager.

One notable symptom of trauma is “hyper-vigiliance”, or an over-sensitivity to threats in everyday situations.

“I was on high alert all the time," he remembers.

His relationships were shallow because he avoided social activities. Even surrounded by those who loved him, he was still alone and fearful.

Addictive Attempts

Determined to be more social, Tom looked for solutions. While they did improve his anxiety, they also came with troubling trade-offs.

One was a popular and controversial legal drug, Phenibut, a synthetic anti-anxiety supplement originally synthesized in the USSR for cosmonauts.

Phenibut acts on the central nervous system by inhibiting the neurotransmitter, GABA. Essentially, it can dull reactions to perceived dangers. Because Tom was not in any true danger, it was a workable solution that gave him the confidence to be more social.

Unfortunately, Phenibut is highly addictive and there are reports of painful withdrawal. Tom remembers one occasion when he forgot to take one of his various anti-anxiety supplements on the way to a movie with his wife and they had to immediately turn back, making them late for the show.

Being tethered to addictive, unapproved medical treatments was clearly not helping him or his relationships.

Ketamine and a Feeling of Unconditional Love

Tom came across a Facebook ad for a new therapy at Novamind’s Cedar Psychiatry in Utah using ketamine, a surgical-grade general anesthesia that was being used to treat mental illness, including social anxiety disorder.

“I didn't quite know what to expect," he recalls of his general aversion to psychedelic-assisted therapy. “This was kind of my last hope."

Desperate for better options, Tom scheduled an appointment and brought his wife with him for support.

Tom remembers the luxury gravity chair that he sat in while the IV ketamine infusion was placed in his arm. He began drifting off into a dream-like state and felt as if he was tipping over backward in the chair, but the fear subsided.

“It’s ok, just let go," he recalls telling himself. For Tom, the psychedelic aspect of ketamine was not about wild hallucinations, but a feeling of ease. “I fell into this black space."

Tom’s thoughts drifted to his wife and he felt unconditional love. Prior to the appointment, he had worried about bringing her, since he felt silently judged for turning to psychedelics for treatment, even though she had never expressed skepticism about the approach.

But that feeling was replaced with one of acceptance. With ketamine, “You get to see yourself in third person," Tom explains. He experienced, at a visceral level, how others saw him and he knew they didn't judge him as he feared they did.

Instead, he could simply be beside his wife. “She held my hand; I felt so loved."

Feeling Less Judged

"Our marriage has skyrocketed," Tom says proudly. He also has more energy to enjoy swimming and going to the gym with his wife.

"I feel like going outside because I don't feel like there are eyes everywhere judging me."

Tom still has more ketamine treatments to go but feels he’s on a better path.

He seems to take challenging social experiences less personally. If someone disagrees with him, there is “zero emotion attached" to the argument.

Without constant rumination about what he’s doing wrong, he’s able to put challenges into perspective.

What Seemed to Work

Tom says that two things, in particular, stand out in his mind about what helped, aside from his wife being at his first treatment.

The first was listening to unfamiliar music. Music can have a calming, meditative effect during psychedelic episodes, allowing people to more deeply drop into a dream-like state. However, listening to familiar music can dredge up unpleasant memories that could distract from seeing oneself in a new light.

The second was Tom’s experience with mindfulness therapies prior to ketamine, including meditation and another called Eye Movement Desensitization and Reprocessing (EMDR).

The basis of both strategies is to embrace difficult thoughts and memories as they come up. Tom doesn’t know whether having these psychological tools in his toolbelt made the difference between successful and unsuccessful ketamine treatment, but he did have the honed skills to address challenging thoughts during the treatment.

So, it is worth noting that people who have come from therapy might be able to use the tools they’ve learned from previous counselors with ketamine. This is why Cedar Psychiatry is careful to prepare patients with the mindfulness tools they’ll need to navigate the psychedelic experience and integrate insights afterward.

It certainly seemed to work for Tom. "It changed my entire life," he concludes.

*Tom is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Fully Present: How Ketamine-Assisted Therapy Helped One Woman Out of Depression

By Greg Ferenstein

Michelle* lived with constant anxiety that she would explode during an argument and enter into a months-long depressive episode. She’d tried so many strategies to manage her mental health, from group discussions to cognitive behavioral therapy, but nothing seemed to work well.

“Most of the therapy I’ve done just kind of muted my symptoms mostly, but I am still walking around with heavy, heavy depression and really terrible anxiety.”

Depressive episodes would socially paralyze her.

“I wouldn’t feel like I had any energy to do anything. I’d isolate myself,” she says. “I'm not social. I don't function besides what I absolutely have to function for.”

She could work but that was about it.

Unfortunately, the most effective solutions for her had intolerable side effects. The generic version of Zoloft, Sertraline, managed her major mood swings but came with “horrible” sweats that left her “drenched” in the middle of the night. Perhaps worse, it severed her emotions.

“It made me not care at all,” Michelle recalls. “I just kind of didn't feel anything.”

After her doctors recommended trying a higher dose, she went looking for something else. Her friends said good things about ketamine, a dissociative psychedelic that is known to help people confront painful topics and manage a range of mental health conditions, including depression.

Michelle was nervous. She had some not-so-positive experiences with psychedelics when she was younger. Even though it was years ago, she didn’t like the idea of losing control of her mind.

The therapists at Numinus made her feel more at ease with their Emotion-Focused Ketamine-Assisted Psychotherapy, which pairs intensive emotional management and trained mental health professionals with multiple rounds of in-person ketamine sessions.

The Ketamine Experience

The psychedelic portions of ketamine treatment typically last an hour and many people report hazy dreams representing unprocessed challenges.

After years of therapy, Michelle believed she knew the source of what she might encounter: being abandoned by her mother as an adolescent and subsequent years in-and-out of near homelessness.

Instead, her most healing psychedelic experiences were simple and pleasant experiences.

She remembers telling her husband, “Maybe this is what it feels like to feel normal.”

The simple absence of anxiety was profound. After one session, she burst into tears.

“I just started crying and crying and crying,” she recalls. “I really felt like it helped me release those emotions, and relieve some of that pain and all of the struggle that I had when I was a child with my family.”

During another psychedelic experience, Michelle set an intention and drifted into a meditative state, daydreaming of swimming. Usually, when water was involved in Michelle’s dreams, it was a nightmare drowning sensation. This watery dream, though, was superbly healing.

“I have been a hyper-vigilant person, always looking for the next thing to crumble in my life,” she says. “But with ketamine, just to even have that feeling that I'm okay—and that I'm happy—was huge for me.”

Introspection, fewer explosions, less depression

In the three months since Michelle had her first ketamine treatment with Numinus, she has learned to better manage her emotional triggers.

One example stands out. Because of their shared traumatizing past, her family has had a tendency to set her off. But the last time they had a fight, Michelle recalls being able to remove herself from the argument, sensing that she was about to explode, and embrace her feelings without becoming overwhelmed by them.

“It's getting easier for me to recognize, even in conversation.”

She feels more in touch with her emotions, and if things start feeling really bad, she can discuss her emotions openly in a way that defuses the situation.

Her relationship with her husband has improved and she is no longer burdened with extended bouts of depression. She’s made incredible progress, but Michelle still struggles with explosive episodes and depression. So, she continues to go in for occasional ketamine treatments.

But she no longer needs antidepressants.

“It has really, really, honestly been the only thing that has helped me feel normal without taking a pill every single day.”

*Michelle is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Rooted in Love: How Ketamine-Assisted Therapy Helped a Frontline Worker Overcome Anxiety and Burnout

By Greg Ferenstein

Christine* had finally managed to get her acute anxiety and depression under control and wean off a decade-long reliance on antidepressants. But when COVID-19 hit in 2020, she became increasingly overwhelmed. Though she had a huge stack of responsibilities—as a mother of three, a wife, and a frontline clinical therapist—Christine was debilitated by constant ruminating fears that she would fail her responsibilities.

“How do you help people when you also feel like you’re drowning?" she remembers thinking.

In her personal life, Christine struggled with a lack of self-worth, which impacted her husband and child.

“I just wouldn't show up as my best self, so I'd be more irritable with them—more easily frustrated with them—even though I was really frustrated with myself.”

The fear and tensions caused further distance from those she loved; she experienced serious physical intimacy issues with her husband, and in social situations, she found herself turning inward rather than being the energetic friend she wanted to be.

Christine began to isolate more and more, describing her collapse inward as a practice of self-care.

“I remember just taking multiple walks a day, just trying to get out of the house.”

Ironically, these attempts took her away from her responsibilities and worsened her mental health challenges.

Feeling defeated, Christine decided to go back on her antidepressant medication to manage her depression. While the medication gave her more energy to be productive, it exacerbated other problems.

“It was really good at helping my depression, but it had the side effect of increasing my anxiety if my dose was too high. And so, there was a lot of playing around with dosages, and I never ever really found something that felt really good.”

The Ketamine Experience

Christine was desperate for a better solution. A few of her therapy clients had told her about their experience with psychedelic-assisted psychotherapy, in both the underground and with ketamine in clinics.

“I had literally never taken any sort of substance to change my state at all. I really had no idea what to expect.”

Christine was still nervous to try psychedelics by herself, but a colleague had told her about a positive experience at Novamind, a psychiatry clinic that specializes in ketamine-assisted psychotherapy. As a frontline worker affected by the stress and trauma of the COVID-19 pandemic, she qualified for their ongoing clinical pilot program for group therapy, where she and two others would undergo three sessions of oral and intramuscular ketamine, guided by a licensed psychotherapy team.

Ketamine, a dissociative anesthetic, can bring patients into a daydream-like state where their mental health challenges morph into insightful visualizations.

Going into her first psychedelic experience, Christine had set the intention of processing her issues of “enough-ness” and expected to find an answer detailing why she was an amazing caretaker. Yet, she got quite a different insight.

Christine began to see images of a large tree, which felt as though it represented a long lineage of caretakers, supporting both her and those she loved.

“What the ketamine kind of showed me was how I was actually connected. And I was a part of something much larger. And for me, that was my ancestry. So, I had these visualizations of seeing myself from above and having this family tree.”

Christine, for the first time, began to realize that she was not the only thing protecting her loved ones or her patients.

“I think it really comes down to this sense that I'm not alone and that these things are not just on my shoulders.”

Christine had placed unrealistic burdens on herself as a mom and as a therapist. She realized she could be imperfect and ask for help and this was enough.

Christine also notes that the group aspects of the therapy were essential to integrating these insights into her life.

“They also had some really powerful experiences, and they could understand maybe the weirdness.”

Psychedelic insights can be unusual. For Christine, it was vital to be surrounded by people like herself who understood the experience and why it was meaningful.

A More Confident Christine

Christine is happy to report that she is fully off her antidepressants and feeling much better.

She finds herself lashing out less in irritation at her family. As a therapist, she finds herself more present and grounded with her clients.

“I feel like my nervous system is a tool that I use with my clients and the more regulated I can be and the more I can feel myself in a grounded place, I can show up better for my clients. So, I do think that I'm giving better quality service.”

Perhaps just as important, she feels more vivacious and connected in her social life.

“In those social situations, I find myself sharing more and being more engaged, worrying less about saying the right thing or something that they wouldn't necessarily want to hear. And coming home or coming away from most situations and not being nearly as drained as I had been over the past few years.”

Christine credits new mindfulness skills with her continued mental stability. During one of her more intense psychedelic journeys, she experienced a so-called “ego death”, which she describes as an out-of-body feeling where she could independently observe different parts of her psyche.

During this daydream, Christine could hear the chatter of her negative, depressive, and judgmental self. "When are you going to post about this on Instagram?" she remembers hearing. But as a disembodied observer, she began to understand that these judgmental ruminations were a part of her psyche trying to care for her.

She could listen to the judgmental and worrisome voices without letting fear overcome her.

Now, when she begins to involuntarily ruminate, she’s better able to practice a form of mindfulness and experience a sense of objective awareness of the voices.

“Even significant family issues can be resolved and those feeling that come from that can be resolved in just a matter of hours, versus something that persists. And I ruminate on and it sticks with me for a very long time, and just kind of keeps me in that bogged down stuck place.”

Overall, Christine is feeling less anxious and depressed. She hasn’t resolved all the issues (she still sees a counselor with her husband) but is grateful for the progress made.

“I loved the entire structure of the experience.”

*Christine is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

How to Get the Most From Your Telepsych Visit

By Mallory Danielson M.P.H., PA-C

Communication over video has become the preferred method of many patients and providers given the situation with COIVD-19. Cedar Psychiatry does have video visits, or Telepsych as we like to call it, available to any patient doing a follow-up or intake visit.

HOW TO UTILIZE TELEPSYCH

  1. Make an appointment, let the staff know you’d like to have this visit be a Telepsych visit.

  2. Before your appointment please go to Cedar Psychiatry’s website (https://www.cedarpsychiatry.com/telepsychiatry) to find your provider’s individualized digital waiting room.

  3. This will take you to doxy.me, a HIPAA compliant, secure website that hosts our video chats

  4. You don’t need to make a log-in, just follow the prompts to let your provider know you’re there

  5. Once they’re ready, your provider will initiate the video chat.

HOW TO MAKE TELEPSYCH THE MOST EFFECTIVE

Most of us have used Google Hangouts or Facetime before but have never used it in a professional setting. To have your Telepsych visits be as effective, personable, and useful as your in-person visits we have a few tips:

1. SHOW UP EARLY

Head to your provider’s digital waiting room 5-10 minutes early to take advantage of doxy.me’s “Pre-call Test”. This will ensure your internet, camera, and microphone are working.

2. FRAME YOUR FACE

It’s hard to do a Telepsych visit when the other person is just a dark shadow or the camera is looking directly up their nose! Try to set up or hold your camera so it is still, so you can see your whole face, and try to have a light shining on your face so you can be seen.

3. CALL FROM A PRIVATE PLACE

Talking about your mental health can be difficult and personal. Make it a little easier by calling from a private place without interruptions. Try calling from a room with the door closed or even your parked car.

4. CALL FROM A QUIET PLACE

Having conversations in the background, the radio going, or other noises can detract from your conversation with your provider. Remember that this appointment is important to your mental health, take it seriously, and keep background noises to a minimum. Use headphones to reduce feedback.

5. BE ENGAGED

Video makes it easy to get distracted and forget proper conversation etiquette. Do your best to keep eye contact by looking into the lens of your camera. Stay still, don’t walk around, or do something else during your appointment. Remember, this is still your visit, respect your time and the time of your provider by making the most of this video call.

Julie Andrews: "Therapy Saved My Life"

Depression, more common than either cancer or heart disease, is the leading cause of ill health & disability worldwide, yet 50% of people with depression don't get treatment.

1 in 4 people will face mental illness at least once in their lifetime, but why do governments only invest 3% of their health budgets in mental health?

Going to a therapist or psychiatrist should be as normal as going to your family doc when you have the flu. Even though it's getting better, the stigma is still out there. So, you can imagine how pleased we were to hear about this conversation on The Late Show with Stephen Colbert:

"Colbert asked Andrews about the decision to discuss her history with therapy in Home Work. Andrews' first stint in therapy took place after her separation from her first husband, when "my head was so full of clutter and garbage." Mike Nichols, who she admired for being clear-headed, was going to therapy and so she gave it a try. As for why she shared this with readers, Andrews replied, "The truth is, why not, if it helps anybody else have the same idea? These days, there's no harm in sharing it, I think everybody knows the good work it can do."

We need to talk more about our mental health. We get this message from society that asking for help is weak, but maybe society needs some therapy. Therapy is cool, psychiatry is rad, and working on your mental health is a sign of strength, not weakness. It's showing up for ourselves so we can be there for the other people in our lives too.

 

 

Episode 40: Dr. Robert Grant on Internal Family Systems Therapy

“What’s healing is the self to part relationship. And that relationship gets built based on the part being able to tell its story without repercussions.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Robert Grant. Dr. Grant is an Internal Family Systems (IFS) therapist, a ketamine-assisted psychotherapist, a pulmonary physician, a professor of medicine at UCSF, a former researcher in HIV prevention and treatment, and a cofounder of the Healing Realms Center. The Healing Realms Center is a clinic specializing in ketamine-assisted psychotherapy.

Dr. Grant is especially well known for his work as an IFS therapist specializing in ketamine treatments. IFS was developed by Dr. Richard C. Schwartz. It is a therapy based on the notion that the human mind is made up of inner parts. And healing involves the cultivation of harmony among these parts. It is commonly used in the treatment of post-traumatic stress.

 

In this interview Dr. Joe and Dr. Grant explored:

 

Here is more information on subjects mentioned in this episode:

 

More quotes from Dr. Grant from the interview:

 

“It was the human connection that was curative. And the mescaline was helpful maybe because it facilitated that connection.”

 

“Other people may trigger different parts of us that give us an opportunity to learn about our inner processes.”

 

“‘Self’ is the part of us that can see our own trauma without being re-traumatized.”

 

“Healing is a process of hearing out that inner dialogue. So we can really develop a relationship with our parts.”

 

“Sometimes spaciousness actually fosters connection because it allows us to see each other more clearly.”

 

“Parts are still there after the healing process. You’re not trying to get rid of them. You’re just trying to allow them to be seen and to play healthy roles that are playful, pleasant, and productive to a certain extent.”

 

Here are some highlights from their conversation:

 

Let’s talk about healing. That’s where I wanted to go next. You said things like, ‘this part needs to tell their story.’ And you gave the example earlier about, maybe someone coming to therapy because they feel confused about whether to stay in or leave a relationship. And that the purpose of the therapy is not to arrive at a conclusion, but to create space for these stories to be heard. Can you tell me what’s healing about having these parts express themselves?  

It’s the beginning of the healing process. So I think that what’s healing is the self to part relationship. And so that relationship gets built based on the part being able to tell its story without causing a reaction or without having repercussions. So creating a connection between the self and the part by listening to their story is an essential step in the process of building those relationships.

We have a number of heuristics which are actually helpful. And if I can digress a bit, the founder, Rick Schwartz, in his most recent iteration of his book with Marta Sweezy, said that IFS could be conceived of as a psychodynamic theory. And so it is in this lineage of psychodynamic process. And because it does embrace the multiplicity of the mind, it allows for conflicting, psychodynamic relationships within the person.

What I like about IFS is that it goes one step in the direction of giving us tools for uncovering exiled or subconscious material. And so a classically trained psychoanalyst might expect to spend hours or days or years listening to the client on the couch, and eventually the subconscious material will bubble up, either in terms of dream interpretation or day time fantasies or behaviors that create ambivalence within them. I mean, they’ll just wait for it. And I love that idea of just waiting, witnessing. And so I have great respect for thoroughly trained psychoanalysts.

And IFS does give us some tools that allow us to move pretty quickly toward uncovering subconscious or exiled material. And so it has a toolbox that allows us to be expeditious. But I don’t think the process is very different from what a psychoanalyst would do. It’s just a little more guided and a little more intentional.

So one of the heuristics that IFS has is called the 6 F’s, and so I can walk us through those. You want to find parts. So whatever part we want to find, we want to see what’s up for the person. It might be that a single part has very strong feelings that need to be heard out. Or there may be a pair of parts that want to stay in or want to get out, a polarized pair of parts. So you want to find the one or two or three that you’re going to work with on that day. And then you want to focus on them, let them know that you’re here to listen to them. And when I say you, it’s actually the client ‘self; is there to listen to them. Now, the therapist’s ‘self’ energy is also very important in this process, so that the therapist ‘self’ and the client ‘self’ are there to listen to the parts. So, you know, it’s intuitive that that’s reassuring. I mean, if you’re wanting to make friends with someone, what do you do? You focus on them. You look them in the eye and you focus and then you flesh out.

So that’s the third F. ‘Tell me more about that. Tell me what that was like for you. Tell me what was the worst part of that or the best part of that? What did you do with that?’ And then there’s this phrase that we use is, ‘how do you feel toward the part?’ And that’s actually a key step because, you know, if you asked me, Bob, ;how do you feel toward that part that’s carrying shame?; And if I say something like, ‘well, I actually dislike that part, it’s annoying. It bothered me my whole life. Why would I be ashamed of it?’ Those are not self qualities. So what that tells you when I answer that way is that it’s not a self to part relationship with being developed. You’re hearing from another part of me that is trying to exile that part carrying the shame. And so you would at that point having asked me how I feel toward the part, but having not heard from self, you would say, ‘okay, can you give attention to the part that wants to get rid of that shame and let’s find out about it. What is it trying to do? What is afraid will happen if we heard  about the shame? What would it rather do if we didn’t have to suppress that part that had all the shame all the time?’

And, you know, and so we change the focus to the part that came up in reaction to the other part, and we continue to do that. And then we’ll ask, ‘how do you feel toward that part that wants to get rid of the shame?’ And, you know, at some point I’ll say, ‘well, I’m curious about what is it trying to do? And I want to know more. And  that’s self energy. And so then that’s our green light to start doing the real work of developing self to part relationships. So the feel toward is one of 6 F’s.

And then and then you want to unblend as much as possible. You want the part to be able to see the self, and the self to see the part and and parts don’t like doing that. They like being connected to self. They like being connected to self so much that they stick to self, like a glove. And so one thing that I like to say is, ‘can we ask the part to give us some distance and spaciousness so that you can see it better and so it can see you better?’ So one of the beautiful things about connection is whether it’s between people or within our parts, within ourselves. Sometimes the spaciousness actually fosters connection because it allows us to see each other more clearly. And then, you know, that can be healthy and relationships as well. Sometimes that relationship I mentioned earlier, ‘do I stay and do I go out?’ Maybe there is a middle ground. It’s, you know, let’s just take some space and, you know, we don’t spend  every day of our lives together. But we think we can walk and have some spaciousness. And that may be all the relationship wants or needs.

And it’s the same way within parts within ourselves, but sometimes asking them to unblend, they’ll say, ‘no, no, I cannot unblend.’ They’re desperate for more attention. But they said, ‘Well, no, it’s if you just give us some space, then I can see you better. You can see me better.’

So there’s unblending and then there’s befriending, just continuing to say, ‘it’s so great that I’ve been trying to protect Bob from feeling shame. You’ve done such a great job. And look how well he’s done in school and that has led to a career. And that’s so great.’ But do you really want to keep doing that all the time? And often they’ll say, ‘No, I’m exhausted.’ I’d rather that Bob, if there were a way for Bob to deal with his shame without me having to work all the time, I would like that, but I don’t think there is a way to do that. That’s why I’ve constructed this job. So the part may say that. You could say, ‘well, you know, I think there is a way to help Bob with the shame without you having to work all the time.’ Sometimes the part would say, ‘I’m not sure that’s possible, but I would want that. So, you know, let’s give that a try.’ And then you can ask, you know, that protective part to rest and it can stay close and watch if it wants, just in case something comes up that makes it afraid. It can step back in if it needs to. But that then gives you an opportunity to go back to that exile, which initially caused the protected part to come up. But that part now is befriended and it’s willing to rest. And so you can work with the exile material.

And then ultimately you would want to get to a point where whatever caused the burden of shame to come to that exile part, then that part can have a chance to leave that situation and unburden that shame. And then the whole system can appreciate that , ‘Yeah, there was a way to deal with the shame that didn’t involve having to compulsively work all the time.’

So the healing process is really one of befriending the parts and airing them out and ultimately giving the exiled parts a chance to be retrieved from the hard situation and then to unburden the beliefs that were important to survive that hard situation. And then to have the rest of the parts come back into the situation, and ask them, ‘did you see what happened there?’ And some of them will come back in and say, ‘oh, yeah, wow, I’m impressed. I didn’t think there was a way to solve that problem. But yeah, there was.’  So great.

And some of them may come back and be a little frightened. Like the example I gave might say, ‘you know, I spent my whole life working obsessively to do well in school. And now what do I do? I don’t know what my job is.’ ‘It’s okay. You know, I’ll work with you. There’s lots of jobs that you could do. Maybe you can work on writing a book or something other than school.’ Maybe oftentimes the job that the protectors want to do has nothing to do with what they were doing. The part of me that wanted to do well in school might want to take up finger painting or, you know, writing poetry like I was doing in college. Maybe they want to go back and do that or, you know, like, hey, who knows? But letting them do what they want, it’s an important part of being a good self for them, a good self leader for them.

I mean the parts are there, they’re still there after the healing process. You’re not trying to get rid of any part. You’re just trying to allow them to be seen and to play their healthy roles, which are roles that are playful and pleasant and productive to a certain extent.

 

Connect with Dr. Robert Grant on the Healing Realms Center website.

Connect with Dr. Joe on Facebook, Twitter,LinkedIn and Instagram

Follow Numinus on Facebook, Twitter, Instagram, and LinkedIn.

Episode 30: Emotion and Transformation with Dr. Les Greenberg

 

“The best way to change an emotion is with another emotion.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Les Greenberg, a world renowned psychotherapist and researcher. He is one of the creators of Emotion-Focused Therapy (EFT) and professor at York University in Toronto. EFT centres around utilizing emotion to transform emotion. It is a different approach from the current major schools of psychotherapy like Cognitive Behavioural Therapy. He is also the founder and director of the Emotion-Focused Therapy clinic where he provides therapy for individuals and couples and trains therapists in EFT.

Dr. Greenberg is the author of 17 books like Changing Emotion With Emotion and Emotion-Focused Counselling in Action. And he has published over 100 scientific papers and has written over 80 book chapters.

Dr. Les Greenberg and Dr. Joe spoke about:

Connect with Dr. Joe on Facebook, Twitter,LinkedIn and Instagram

Follow Numinus on Facebook, Twitter,LinkedIn and Instagram

 

Here are some highlights from their conversation:

You’ve spoken about the idea of the importance of using emotion to transform another emotion. Can you speak to why that is important and how that works?

My contention is that amygdala-based painful emotions like core fear and core shame are impenetrable to reason. You can’t reason somebody out of these core painful feelings because emotion is a whole embodied experience. And you’re organized to run away. You have a sinking feeling in the stomach. It’s not produced by cognition. It’s produced automatically by the activation of emotion schemes.

We have to find a way to work with these painful emotions and the best way to change an emotion is with another emotion. Spinoza was the first person to state a principle like this. He said, ‘the only way to change an emotion is with an opposing and stronger emotion.’

I think this can be thought of in primitive behavioural terms that some of the emotions are organized as withdrawal emotions. With fear, you run away. And shame, you shrink into the ground. Approach emotions like assertive anger or the sadness of grief, you really are moving forward and towards.

So if I have a client and I can take them to their core feeling of fear or shame and they’re organized to run away, then I can help activate assertive anger or the sadness in which you cry out for comfort or reach out for the lost object.

You can’t run away and thrust forward at the same time. So we’ve now got two opposing action tendencies. The new action tendency is going to transform the old one.

Hebb stated the first law of neuropsychology as “neurons that fire together, wire together.” So if you think of emotion as an emotion scheme, a network that fires. So when you fire shame and at the same time, simultaneously, you fire off anger.

Let’s say you have a drunken, physically abusive father. When you first imagine him in front of you in an empty chair, it fires off these feelings of fear and shame and you shrink and you want to run away. But then if I can help you to feel assertively angry–’I should have had a father who treated me right. I deserved to not be abused’–it generates assertive anger. ‘I’m angry at you for having treated me so unfairly.’

Now this new emotion undoes the old emotion. It doesn’t replace it. It actually transforms it and synthesizes with it to develop a truly novel experience. So your self-organizing system is re-organizing. And maybe the shame, the anger synthesizes with the shame to produce confidence or security or calm or something new. And this is a developmental process.

And rather than thinking about it in learning theory terms like exposure leads to reduction. This actually comes from a Piagetian notion that the development occurs by the synthesis of co-activating schemes.

At a more practical level, the best way to change an emotion is with another emotion.

Teletherapy and Cyber Security

Important Disclaimer: This document is for informational purposes and general guidance only and is not advice on any specific regulatory or legal matter. Always consider getting qualified advice on the facts of any matter before proceeding.

In a world in the midst of the COVID-19 pandemic, therapists have had to adapt rapidly to continue offering psychotherapy. The main form of adaptation has been to transition to delivering  remote therapy, whether via telephone or video conferencing. Existing bodies of research have shown online therapy to be effective, but clients and therapists often still have concerns about privacy and security. Now is the time to directly address those concerns and it has fallen on me, as Numinus’s Clinic Manager to take on this challenge. My background as both a therapist and information technology professional helps me to understand and explain our approach to the delivery of remote sessions in the province of Quebec.

Numinus has always had a few therapists providing remote sessions to their clients; now it is the entire team. We have always abided by the rules governing the practice of teletherapy in our jurisdiction and will continue to do so. The Ordre des psychologues du Québec (OPQ), the governing body for psychologists and psychotherapists in Quebec, has produced several documents outlining the ethical and practical guidelines for remote therapy (in French only). I will briefly summarize these documents:

OPQ Guidelines for Psychologists/Psychotherapists practicing in Quebec

Encryption, End-to-End Encryption, and You

Encryption is a way to obfuscate the contents of a message, or video, so that only someone with the proper decryption key can undo the encryption and see the contents of the encrypted communication.  End-to-End (E2E) encryption adds an extra layer of security so that even the provider of the tool or service cannot decrypt the contents of communications, even if compelled to by law, or hacked by a malicious actor who inserts themselves as a “man in the middle” at the corporate level (e.g., at a software company’s servers that offer the teleconferencing solution).

The most common questions that arise from these guidelines relate to encryption. Does your therapist use a tool that encrypts your communication, preventing casual electronic eavesdropping by unsophisticated attackers? Good odds that the answer is yes, and at Numinus, we definitely do. All the tools listed by the OPQ use some form of encryption in order to prevent electronic eavesdropping.

PIPEDA, HIPAA, and Quebec’s “substantially similar” legislation

You may have heard people talking about various names for electronic privacy legislation passed in various jurisdictions and how they relate to remote practice. In the United States, there is HIPAA, in Canada there is PIPEDA. In Québec’s there is An Act Respecting the Protection of Personal Information in the Private Sector, An Act to amend the Act respecting health services and social services, the Health Insurance Act and the Act respecting the Régie de l’assurance maladie du Québec, all of Québec’s privacy laws relating to health records. The most important things to know about all of these laws, from Numinus particular perspective:

What you can do to help ensure that your sessions remain confidential

When it comes to security, you are more likely to have your remote session’s privacy violated by a person physically listening in from a nearby location than by a sophisticated state actor capable of breaking encryption or inserting themselves as a “man in the middle” attacker (e.g., the National Security Agency in the United States). The corporations offering these communication services have a vested interest, both legal and financial, in maintaining the privacy of these communications, so unless compelled by court order, they will not intercept any remote communications or turn over any recordings (which they all state that they do not even make in the first place). One could argue that you are as likely to have an in-person session bugged by law enforcement as to have a court order issued mandating that a session be captured and decrypted. If this is a real concern of yours, due to your work or other factors (e.g., you are a high level government official, famous actor, or crime lord), then online sessions might be best avoided! If you are not generally at risk of being a target of a state-level actor or law enforcement, you can also do some basic things to best assure your privacy:

  1. Make sure you are initiating sessions from a place where you can monitor, and ideally control, your environment to prevent someone from physically listening in.
  2. Do not use public WiFi networks when engaging in remote therapy unless there is absolutely no other choice. And if you must use public WiFi, then you must use a Virtual Private Network (VPN) software solution to provide an additional layer of protection to your communications.
  3. Regularly run virus and malware scans of your computer, or use your mobile device for your remote session, as they are far less prone to viruses and malware.

I hope this helps to inform you and address any concerns you might have, whether as a therapist delivering remote sessions, or a client on the receiving end!

Mental Health Services Transition to Online Care

The coronavirus pandemic is wreaking unprecedented havoc on our healthcare system, economy and communities. The combination of high stakes, uncertainty, lack of control and limits on social connection is creating a perfect storm for psychological distress. Undoubtedly, there is a mental health crisis lurking underneath the public health and economic crises unfolding before our eyes. And this, while everyone is forced to stay home.

The one bit of good news is that psychotherapy works online. Numinus has been offering virtual sessions for many years. But in the last week, we managed to transition our entire clinic operations online. While the virtual therapy session takes some getting used to—for clients and therapists alike—the results have been positive. Clients are grateful that they continue to have access to services. Sarah, one client said “I still had a real connection with my therapist, still able to make progress on issues that I have been working on for a while, and reduction in anxiety from what’s going on today.” Therapists also report that they are having positive experiences despite the remoteness. Jessica said “I’ve been pleasantly surprised by the quality of the connection I’m making with my clients despite the distance.” Julien even found some clinical advantages to virtual sessions: “I also find that there are advantages to meeting clients in their natural environment.”

The research on virtual psychotherapy supports these experiences. A 2012 review paper by Backhaus et al. concluded that virtual therapy is “feasible, has been used in a variety of therapeutic formats and with diverse populations, is generally associated with good user satisfaction, and is found to have similar clinical outcomes to traditional face-to-face psychotherapy.” Surprisingly, according to Simpson and Reid (2014), meeting a therapist online does not seem to compromise the quality of the client-therapist relationship, which is an important ingredient in successful therapy. So good quality mental health care is available online.

This mental health crisis is affecting organizations as well, as they rely on the sustained performance of their people to adapt to sudden, tectonic shifts in the business landscape. Virtual psychotherapy may be an essential ingredient to maintain employees health and functioning at work. Many organizations try to support employee well-being by offering extensive health insurance benefits. In this post-COVID world of social isolation, the primary headwind to employee wellness are feelings of anxiety and disconnectedness that arise from suddenly being thrust into working from home in an uncertain world. Psychotherapy is typically covered under these policies, but often not sought out. Alayacare, a Montreal-based health tech company contributing to COVID-19 solutions, is encouraging employees to make use of these benefits. CEO Adrian Schauer says “we are aware that some of our people are having difficulty coping with the current circumstances, which is totally understandable. We feel like working with an organization like Numinus to give our people access to licensed mental health professionals just makes sense.”

The insurance companies providing mental health coverage are just as motivated to facilitate services. For one, like many of us, they are often looking for ways to make meaningful contributions to their communities in this crisis. They also fundamentally want their customers to get good value for their policies, or else organizations won’t renew their policies. For example, SunLife’s  indicates: “We want to ensure plan members continue to receive the health care they need. Now, we’ll cover virtual services for appointments where they do not need direct physical therapies.”

Do you work with or represent an organization looking to support its employees through this crisis? Have a look at Numinus comprehensive offering for organizations during the COVID-19 crisis.

Eco-Anxiety: What It Is and What To Do About It

About a year ago, a friend of mine mentioned to me that she was interested in attending a “climate change bereavement group” in our neighbourhood. I’d never heard of such a thing, but on reflection it really made sense. People are really upset about climate change and don’t know what to do about it. I’m seeing more and more clients show up with these concerns in my office. I’m seeing more and more news and social media stories about it. And I’ve even begun speaking about it in the media myself. The technical term for this upset feeling is “eco-anxiety” and it’s definitely a thing.

Climate change and mental health

So what is it exactly? The term has emerged from an increasing concern for the diverse set of mental health problems that can arise from climate change. Superstorms, floods, droughts, heat waves, wildfires and other extreme climate events can have disastrous consequences on people’s lives. Individuals can be killed, injured, or forced to leave their homes and this can be devastating to families and communities. Mass migrations can disrupt lives at a larger scale. Post-Traumatic Stress following extreme climate events is becoming more common, as are spikes in fear, anxiety, depression, and irritability. It is worth noting that climate change events are more likely to affect the lives of the vulnerable, such as the poor, and therefore these populations are more susceptible to the acute impact on mental health.

What is eco-anxiety?

The American Psychological Association (APA) defines eco-anxiety as “a chronic fear of environmental doom” (report). As the definition suggests, eco-anxiety not a response to an acute event, but a state of mind that arises gradually as we watch the slow and frightening consequences of climate change unfold. Eco-anxiety can manifest in intense worry and rumination, generalized anxiety, insomnia, panic attacks, feelings of sadness, loss, guilt, hopelessness, and irritability – in other words, symptoms of anxiety and depression. The term has not made it into the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (2013), but it will surely be considered in future editions as the magnitude of the problem becomes clear. A 2018 Yale survey estimated that 70% of Americans are “worried” and 29% are “very worried” about climate change, while 51% feel “helpless.” While little data is available, eco-anxiety appears to affect younger generations (e.g. Millennials, Gen Z) more than older (e.g. Gen X, Baby boomers). The mental health community is increasingly engaged with the impacts of climate change: The APA assembled a task force in 2008 and published this 70 page report in 2017 to build awareness and educate professionals.

The emergence of the term eco-anxiety has been met with some resistance. Some skeptics roll their eyes at yet another buzzword for navel-gazing complainers. Others object to medicalizing a very real and appropriate feeling. As someone who counsels clients with eco-anxiety (and experiences it personally), let me tell you that it is real and causing a lot of suffering. I also believe that, whether there is a diagnostic term for it or not, anxiety is a perfectly rational response to a real threat to our way of life on this planet. And labeling the response with a diagnostic term should not invalidate or diminish the scope of the problem nor the person suffering. All of that said, we need to learn how to cope with it and get on with the job of finding solutions.

Understanding anxiety

Fundamentally, eco-anxiety is a form of anxiety like any other. It is a psychophysiological response to a threat to our safety or well-being. While fear involves a specific reaction to an imminent threat, anxiety is a diffuse response to a non-specific or uncertain threat. So if you’re an antelope in Africa and a lion jumps out at you from the bush, you feel fear. If you have health anxiety (aka hypochondriasis), you worry about aches and pains being signs of serious or fatal health problems. In eco-anxiety, the threat is broad and abstract and therefore hard to contain and resolve. It is somewhat similar to the anxiety many people felt in the 60s when they believed the world was on the brink of nuclear war. The content of anxious thoughts may vary, but the underlying mechanisms and emotions are the same. And that’s good news because many of the same coping strategies are helpful.

The key to coping with eco-anxiety is to build psychological resilience. That is to say climate change is happening right now and it is affecting people all over the world. We all need to find a way to be with the difficult emotions that arise in consequence and continue to be engaged with the process of finding a solution. Here’s how to get there:

What to do about it

1. Manage your mood

Because climate change is an abstract threat, whether you experience eco-anxiety or not will depend on how you think about it. Unfortunately, it is also complex, multi-faceted, and highly technical, which means it’s difficult to get your thoughts straight about it. Our brains prefer information that is packaged in simple, concrete narratives and therefore rely on heuristics and shortcuts to cope with complexity. This pragmatic bias can be helpful – necessary even – for surviving and getting things done. But it can also create biases and distortions in our thinking, especially in the face of threat. People fall victim to a number of classic Cognitive Distortions when stuck in an eco-anxiety worry loop, such as catastrophizing, black and white thinking, and emotional reasoning. For example, I worked with a client who became very preoccupied with death following the release of a major climate change report last year. We were able to get him unstuck by unpacking all of the automatic appraisals he made of the danger. It’s not that there isn’t any danger, it just that the danger needs to be appropriately contextualized.

Unfortunately, the news and social media are not necessarily helping in this respect. Our screens are perpetually showing us provocative content about climate change. Sometimes the information is accurate, but often it is distorted – one way or another – by some hidden agenda and designed to hijack our attention. So it’s important to manage your “information diet,” by assuring an intake of high-quality, nourishing content.

Climate change is stressful enough; you don’t need your brain piling on exaggerated or false beliefs about what’s actually going on in the world. So, you need to become an expert at catching and correcting these cognitive errors. If books such as “Mind Over Mood” and “Cognitive Behavior Therapy” aren’t sufficient, a direct plan of action with a Cognitive Behaviour Therapist can help. Once these patterns of negative thoughts become familiar to you, mindfulness can be a useful tool for letting go of the unhelpful ruminations churning in the background of awareness. Mindfulness can help with cultivating the clarity and focus required to make sense of all the news, social media, and chatter on the topic and then engage actively with what matters most to you. Check out The Mindful Way Through Anxiety or attend a Mindfulness-Based Cognitive Therapy workshop near you.

2. Connect with others

Humans are social animals. We don’t have big teeth, strong muscles, or speedy legs. It’s our capacity to cooperate with others at a large scale that allowed us to adapt to basically every niche on the planet. As such, evolution has made us highly dependent on one-another for a sense of safety and well-being. This is especially true when we are upset. Nothing helps calm our nervous system more reliably and sustainably than a safe and secure connection with another human.

Unfortunately, withdrawal and avoidance are common features of anxiety and mood disorders. This is one of the cruel realities of the mood feedback loop. When we feel down or worried, we often turn our attention inward and seek refuge, rather than searching for a solution outside of ourselves. This internal shift pulls us away from others and we spend more time alone in our heads, ruminating and worrying. Overtime, our energy and motivation decline and the whole thing snowballs.

Coping effectively with eco-anxiety requires that we reach out to others for support. Do not suffer alone. The emergence of eco-anxiety in public discourse is raising awareness and helping people build a common vocabulary, which should make it that much easier to support one another. The appearance of support groups all over the world and the internet is a really good sign.

3. Stay engaged

Recall that anxiety is our body’s reaction to a threat. It’s essential to understand that all that uncomfortable activity that arises in our bodies and minds in the face of threat – increased heart-rate, muscle tension, surge of energy, hyperfocus, etc. – actually serves an important function: to help us rise to the challenge. If we stay home and worry all day, we just stew in our own restlessness. On the other hand, if we can find a way to leverage that energy and actively meet the threat, we’ll feel much better. This effect is not just about releasing some pent up energy. We may actually be able to solve some problems and enjoy a greater sense of self-efficacy. The benefits of taking action can go even deeper than that. When our actions are aligned with our emotions and our core values and sense of purpose, we gain access to a profound sense of meaning, wholeness, and peace.

Purpose-based coping is an ideal fit for eco-anxiety. In addition to reducing anxiety nerves, it also nurtures more prosocial values. Many of us feel compelled to help with climate change out of compassion. Taking action in this way aligns our nervous and compassionate energies, which really charges up our motivation. All of that said, it is important to balance a desire to do good in the world, with self-care and equanimity. There is only so much we can accomplish in any given day and a burnt-out activist is not going to be much help.

So, in addition to getting your thoughts straight and staying connected to others, here are some things you can actively do to reduce your eco-anxiety and contribute to our collective effort to combat climate change:

You could also get more involved with organizations that are actively working to fight climate change. Here are a few options in Canada:

There’s actually a lot of work to do on climate change and we need everyone’s help. Imagine if all of the energy stimulated by eco-anxiety is channelled into action directed at finding solutions for climate change. People will feel empowered and aligned and together, as a global community, we will be on our way to righting the climate ship. That outcome is incredibly inspiring to me and I hope you share my excitement.